tbuckley/cabot-search huggingface dataset:
Using real-world patient experiences to inform point-of-care decisions and care management strategies in urothelial carcinoma.
Authors: Tariqa Ackbarali, Stephanie Chisolm, John L. Gore, Joshua J Meeks, Neal D. Shore
Journal: Journal of Clinical Oncology (2022)

280 Background: Approvals of targeted therapies and immune checkpoint inhibitors hold the promise of improving long-term survival in patients with urothelial carcinoma. Competence gaps that were identified prompted the design of a unique educational series for the urology-oncology team. Optimal management of urothelial carcinoma relies on effective patient-provider communication and decision-making. To provide an integrative learning experience, the patient voice was embedded into the clinical content through shared insights and patient-reported data. Methods: A 4-part CME series was launched live-online in October 2021 in partnership with the Large Urology Group Practice Association and remains on-demand through October 2022 at UroCareLive.com and OMedLive.com. A companion patient program was held in September 2021 in partnership with the Bladder Cancer Advocacy Network and remains on-demand at CancerCoachLive.com. Behavioral assessment of preferences and attitudes toward managing patients were examined throughout the CME series and patient/caregiver program. A planned analysis of the data from these questions will determine patient and clinical impact. Outcomes from the patient program were analyzed and presented during the CME series followed by expert-identified strategies to improve clinical practice. Results: To date, 775 clinicians and 15,193 patients have participated in the educational initiative. Of the patient-reported experiences and preferences: 44% prefer to discuss benefits and risks of treatment options; and while 85% prefer to make decisions with their team, 67% felt overwhelmed and ultimately allowed their team to select therapy. Patient insights revealed challenges related to quality of life, side-effect management, and disease management. Patient-provider disparities were observed across preferences for point-of-care treatment discussions and quality of life challenges. Clinical and patient impact following integration of the patient voice will be analyzed. Conclusions: The initiative contributed to the provision of valuable patient insights and preferences based on real-world experience which were integrated into provider education. Increasing this awareness fostered practical strategies and discussion to improve patient-centered care. Education incorporating the patient voice into provider education can further sensitize clinicians to patient concerns and facilitate point-of-care decision-making.
Addressing social determinants of health for colorectal cancer in the African American population: STAT (Screen, Trust, Access, Treat) phase I study.
Authors: Emily Coe, Marta Induni, Diane Royal, Dexter Shurney
Journal: Journal of Clinical Oncology (2022)

143 Background: Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer deaths among African Americans, who have the highest CRC rates compared to other racial/ethnic groups, in the United States. STAT (Screen, Trust, Access, Treat) is a three-phase study assessing attitudes and perceptions related to disparities in CRC screening, treatment and clinical trial participation in the African American population. STAT Phase I surveyed attitudes/perceptions among health care providers (HCPs) and Phase II is ongoing to survey African American patients with CRC; in Phase III, data collected from Phases I/II will be used to design and test multiple interventions to reduce CRC disparities among African Americans. Here we present findings from STAT Phase I. Methods: Using non-probability and convenience sampling methodology, a survey link was exposed to over 3,000 HCPs through partnering non-profit health care organizations. The 20-item survey evaluated practitioner views on strategies for overcoming social determinants of health (SDOH), improving CRC outcomes among African Americans, and barriers/motivators for clinical trial enrolment. Results: Respondents (n = 109) comprised oncologists (53%), primary care providers (29%), gastroenterologists (2%), and representatives from other specialties (16%). They were predominantly White/Caucasian (65%); 22% were Asian/Asian American, 11% were African American/Black, and 6% were Hispanic/Latino. To overcome SDOH disparities, most HCPs used translation/interpreter services (83%), offered patients information in multiple languages (76%), and asked them to repeat back care instructions (73%); however, fewer offered provisions such as SDOH assessments (50%), access to financial assistance (66%), and transportation services (45%). Most HCPs agreed or strongly agreed they were prepared to care for patients from cultures differing from their own (91%), with health beliefs conflicting with Western medicine (71%), and with limited health literacy (83%). Increased community-based education (85%), community access to stool-based cancer screening tests (71%), and improved access to primary care physicians (69%) were viewed by HCPs as the favoured approaches to improve CRC outcomes among African Americans. Lack of awareness (43%) was reported as the predominant barrier to clinical trial enrolment, and HCPs agreed or strongly agreed that a patient eligibility screening system (86%) or clinical trial alert system (73%) would be a motivator to engage in clinical trials. Conclusions: Results from STAT Phase I reveal opportunities for HCPs to overcome inequities due to SDOH. Together with ongoing/planned research in STAT Phases II and III, these findings could inform strategies to reduce existing disparities in CRC care and improve outcomes for the African American population.
Evaluating healthcare system–level racial disparities in mortality following lung cancer resection among Medicare beneficiaries.
Authors: Sidra Bonner, Nick Kunnath, Justin Dimick, Jennifer J. Griggs, Andrew M Ibrahim
Journal: Journal of Clinical Oncology (2022)

156 Background: Racial inequities in lung cancer surgical quality are well documented yet understanding the variation in racial inequities across healthcare systems remain limited. Therefore, in this study the variation in racial disparities mortality across healthcare systems was evaluated. Methods: Using 100% Medicare fee-for-service claims, we analyzed data on Medicare beneficiaries between the ages of 65- and 99-years old undergoing resection for lung cancer. All patients undergoing resection for lung cancer between 2014 and 2018 were included. Clinical risk-adjusted 30-day post-operative mortality rates for an overall health care systems as well as rates for non-Hispanic Black and non-Hispanic white patients within each of system were evaluated using multivariate logistic regression. The variation across all healthcare systems performing at least 5 operations for each racial group was performed. A total of 216 healthcare systems were included. Results: Overall, 82,978 patients were included with mean (SD) age of 73.7(5.5) years and racial composition of 7,124 Black patients (8.6%) and 75,854 White patients (91.7%). Of these 216 systems, 90 (41.7%) had significant disparities with the worst mortality in Black beneficiaries. Of these systems with significant worst mortality for Black patients undergoing resection for lung cancer, the odds of mortality of Black compared to White patients ranged from OR 1.04 (95% CI 1.01-1.08; P &lt; 0.001) to OR 2.9 (95% CI 2.6-3.2; P &lt; 0.001). There was weak but statistically significant association between system overall mortality and the Black-White difference in mortality (R = 0.14; P &lt; 0.04). Conclusions: Our findings provide justification for system- level interventions to address disparities in surgical care for Black patients undergoing resection for lung cancer. Moreover, our findings suggest that quality improvement efforts to improve overall quality of surgical care that do not focus on the care of Black patients may be insufficient for reduction of disparities.[Table: see text]
An assessment of patient-provider communication surrounding tumor genetic profiling in thoracic oncology.
Authors: Julia Josowitz, Mohana Roy, Rhonda Larsen
Journal: Journal of Clinical Oncology (2022)

285 Background: Thoracic oncologists regularly order mutational testing for lung cancer, called the Stanford Actionable Mutation Panel (STAMP) at the Stanford Cancer Center, that assesses for somatic tumor based mutational testing. This project surveyed patients who had this testing and assessed their understanding of the test’s purpose and results in thoracic oncology. We also gathered information about which providers on the care team are conducting this counseling and time spent on patient education. Methods: This quality assurance project was deemed exempt from IRB review. We obtained an EHR query of patients who had the STAMP testing between July 2020 and July 2021, which was kept in a password protected file in a secured shared folder. Patients were contacted by phone using Doximity Dialer and answers were recorded in Redcap as the questionnaire was administered over the phone. Patient responses were labeled using a random number generator and no protected patient information was recorded. Results: The EHR query of patients who had the STAMP test performed in the last year resulted in 77 unique patients and 34 patients agreed to complete the survey. The majority of respondents (73.5%) knew that their physician or oncologist had ordered the STAMP test for them. Of those patients, the majority (84%) stated that their provider, most commonly their oncologist, explained the purpose of the test. The majority of respondents (64%) stated that their provider, most commonly their oncologist, had discussed the test results with them, which usually took approximately 5-10 minutes. Almost all respondents (93.8%) felt that they had time to ask the questions they had regarding their results. 43.8% of respondents stated that their test results changed their treatment options and 18.8% were unsure. Similarly, 43.8% of respondents stated that they had a targetable mutation, while 25% were unsure. Overall, 42.9% of respondents felt confident in their understanding of their test results, 33.3% were very confident, 4.8% felt neutral, and 19% were not confident in their understanding. Conclusions: In this single center survey, thoracic oncology teams appear to be communicating effectively with their patients about the purpose and results of molecular testing. However, patients were more uncertain about how the test influenced their treatment, identifying a potential area of improvement in patient education.
Improving plan-of-care visit completion.
Authors: Nicholas Rinaldi, Vanessa March, Serena Wiseman, Susan McInnes, Bassam N. Estfan
Journal: Journal of Clinical Oncology (2022)

288 Background: Plan of Care Visits (POCV) facilitate communicating daily plan of care among providers, nursing, and patients and their families together at the bedside. This discussion standardizes how patients and caregivers collaboratively develop treatment plans that provide the highest quality of care. Daily Plan of Care Visit Completion is expected to improve patient experience with regards to provider effectiveness and interaction. Improved opportunities for understanding, communication, and patient care planning amongst patients, patient family members, and caregivers are a function of Plan of Care Visits. The documented completion of daily POCV in 2020 on the inpatient solid oncology unit was 42% compared to an expected target of 80%. Methods: Team utilized A3 thinking and tools including process mapping, trips to gemba, brainstorming, 5 Whys and fishbone to determine which Potential Root Causes drove failure to complete POCV. Results: Team identified multiple root causes including: Lack of awareness amongst providers that POCV needs to be completed Lack of provider understanding of how to complete a POCV Inconsistent notification of the nurse and staff of when POCV are occurring. Providers unaware of the results of their POCV documentation completion rate Physician attestation templates do not include an option for proper POCV documentation. By implementing retraining and standard procedures for handoff and setting expectations at the start of each change of provider, the team was able increase POCV completion. The subsequent development of a routine to notify staff of their performance daily (and later weekly), and the integration of the POCV completion documentation option into their attestation enhanced completion from 42% in 2020 to 74% in 2021 to 85% in 2022. Conclusions: Following our QI project, POCV completion exceeded the original enterprise target of 55% and revised target of 80%. Improvement in POCV has been sustained for over a year. POCV completion led to improved communication between physicians and nurses on the inpatient unit. The standardization of the process led to consistent completion and improved interaction with the patient. The interdisciplinary care and team were a large contributor to the success of this process.
The association of limited health literacy with frailty, health-related quality of life (HRQoL), and health care utilization among older adults with cancer: The CARE Registry.
Authors: Coryn Stephenson, Chen Dai, Christian Harmon, Mackenzie Elisha Fowler, Smith Giri, Darryl Alan Outlaw, Robert Hollis, Smita Bhatia, Grant Richard Williams
Journal: Journal of Clinical Oncology (2022)

157 Background: Health literacy (HL) is a patient’s ability to obtain, process, and understand health information. Limited HL can act as a barrier to communication and access to medical treatment and lead to poor identification and management of comorbid conditions, resulting in frailty and impaired HRQoL; these issues remain unstudied in the geriatric oncology populations. We aimed to (1) describe the prevalence of limited HL; (2) examine the association between limited HL and frailty, HRQoL and healthcare utilization in older adults with cancer. Methods: The CARE registry prospectively enrolls older adults (≥60y) with cancer seen at UAB. Patients complete a patient-reported geriatric assessment. A single-item screening measure of HL (Stagliano et al. JABFM 2013) was also completed by the participants. Frailty was defined using the 44-item CARE frailty index (based on deficit accumulation). Multivariable analysis examined association of limited HL with CARE frailty index, HRQoL, and health care utilization, adjusting for age, race, sex, education, cancer type/stage and treatment phase. Results: The cohort included 475 participants with a mean age at enrollment of 69.4y; 61.9% were male; 18.9% were non-Hispanic Black. The most prevalent cancer types included colorectal (34.9%), pancreatic (17.5%) and hepatobiliary (11.4%) cancers. The prevalence of limited HL was 33.3%. Participants with limited HL were less educated (&lt; HS: 23.4% vs. 4.7%, p= 0.01), older (71 vs. 68.5 years, p&lt; 0.001), more likely to self-report as Black (26.6% vs. 15.1%, p= 0.009), and disabled (19.6% vs. 11.7%, p&lt; 0.001). Patients with limited HL had a higher prevalence of frailty (57.6% vs 22.1%, p&lt; 0.001) and hospitalizations (57.0% vs 45.4%, p= 0.036), as well as lower physical (39.5 vs. 46.4 p&lt; 0.001) and mental (42.9 vs. 49.2 p&lt; 0.001) HRQoL. In multivariable analysis, older patients with limited HL had 3.9 higher adjusted odds (aOR) of frailty (95% CI 2.4-6.3), worse physical (aOR 2.2, 95%CI 1.4-3.6) and mental (aOR 3.2 95%CI 2.0-5.2) HRQoL, and increased hospitalizations (aOR 1.8 95% CI 1.2-2.8), compared to those with adequate health literacy. Conclusions: Older cancer patients with limited HL had higher adjusted odds of frailty, lower physical and mental HRQoL scores, and higher odds of a recent hospitalization. Interventions to address limited HL should be explored in this vulnerable and growing cancer population.
Implementation of a telemedicine-based genetic counseling program in a large community oncology practice.
Authors: Smita K. Rao, L. Johnetta Blakely, Kate Small, Stephen Matthew Schleicher, Natalie R. Dickson
Journal: Journal of Clinical Oncology (2022)

393 Background: Genetic testing is an integral part of cancer care. To optimally facilitate testing, genetic counselors (GC) provide interpretation and direction for treatments in certain applicable solid tumors. A telemedicine (TM) genetic counseling program was initiated in 2019 at Tennessee Oncology, a large community oncology practice spanning over 30 clinical sites throughout Tennessee and Georgia. Methods: Appropriate patients were identified and referred through the Electronic Medical Record (EMR) for genetic testing based on current National Comprehensive Cancer Network (NCCN) guidelines. All counseling sessions were scheduled over TM to the patient’s home to enhance convenience, broaden access, and decrease no-show rates. Physician education regarding result-dependent appropriate screening recommendations per NCCN for mutation positive patients were provided through email communication and dedicated GC notes in the EMR. Results: Between 2019 and 2021, GC referrals per year grew from 195 to 840. Of these referrals, 84.6% of patients completed GC consultations, all of which were facilitated through TM. Of completed consultations, 81.4% underwent testing. Average time from referral to GC consultation was 8-13 business days. The no-show rate was low (&lt; 7%). This program started at 1 clinic in 2019 and is now offered for patient care in 16 clinics across the state. Conclusions: Our program illustrates how remote GC programs are an effective choice for scaling genetics care across a large community oncology practice. Deep integration of TM-based genetic counseling within the EMR helps identify high-risk patients, improves test adoption, patient keep-rate and turn-around-time therefore helping to better patient outcomes. This quality assurance program is an important part of comprehensive cancer care that we can provide to our patients and their families.
Socioeconomic factors and outcomes among patients with recurrent/metastatic head and neck cancer receiving immunotherapy.
Authors: Natalie F. Uy, Kevin Ng, Jenna M. Voutsinas, Vicky Wu, Cristina Maria Merkhofer, Diane Tseng, Nicholas Peter Giustini, Sylvia Lee, Christina S Baik, Rafael Santana-Davila, Keith D. Eaton, Cristina P. Rodriguez
Journal: Journal of Clinical Oncology (2022)

153 Background: Immune checkpoint inhibitors (ICI) are now a therapeutic standard for recurrent/metastatic head and neck squamous cell cancer (R/M HNSCC). There is limited data on the impact of demographics and socioeconomic (SES) factors on outcomes in this population, and we sought to evaluate these in our single institution cohort. Methods: R/M HNSCC patients (pts) receiving ICI were retrospectively reviewed from an institutional database. SES factors included income, distance to center (dist), marital status, race, and insurance. Median household income by residence zip code was obtained from the US Census Bureau. Time to ICI initiation (TTI) was time from initial visit recommending ICI and first ICI dose. Opiate use was calculated using morphine equivalents prior to ICI initiation and either at best response or end of ICI if no response. Associations between SES factors with overall survival (OS) and TTI were assessed using Cox proportional hazards regression. Binary outcomes were assessed using logistic regression and included ER visits/unplanned hospitalizations (UH) and increase in opioid use. Analyses were adjusted for disease characteristics, smoking status, ECOG, and demographics. Results: Between 1/2012-12/2019, 152 pts received ICI; 124 (82%) were male, with median age of 64 years (range 23-90), and 103 (68%) were partnered/married. The most common races were 114 white (75%), 14 Asian (9%) and 6 Hispanic, any race (4%). Out of 149 (98%) insured pts, 27 (18%) were Medicaid and 69 (46%) Medicare. Median dist was 39 miles (Q1 21, Q3 100), and median income was $80,586 (Q1 $61,202, Q3 $103,059). The most common primary sites were oropharynx (36%), oral cavity (22%), and nasopharynx (7%); 29 (19%) had an ECOG ≥2. While on or within 100 days of ICI, 69 (45%) had ER visits, and 57 (38%) had UH. Increased dist was associated with improved OS (4 th vs 1 st quartile, p = 0.0002; HR 0.33; 95% CI [0.18,0.59]); we observed no other SES association with OS. Increased opioid use was associated with Medicaid/no insurance (p = 0.05; OR 2.89; 95% CI [1.02,8.77]). No SES association with TTI was found, although there was a nonsignificant trend of higher TTI with increasing dist. We saw no correlation with ER/UH and any SES variables. Conclusions: Among R/M HNSCC pts receiving ICI, insurance had an impact on opiate usage, suggesting more advance disease/higher burden of symptoms and indicating need for augmentation of supportive care in this group. Higher dist was associated with improved OS, even accounting for performance status, which may reflect increased resources in this group. Further studies should examine pt factors that may contribute to disparities in the setting of novel therapies for R/M HNSCC pts.